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Simplified Virtual Surgical Planning Method for Reconstruction of Secondary Maxilla and Mandibular Defects Using Free Bone Flap

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Abstract

Objective

Free fibula flap is the commonly used microvascular free tissue transfer for maxillary and mandibular reconstruction to restore form and function after ablative procedures. Bony reconstruction is an important aspect of reconstruction. This paper describes our technique in using virtual surgical planning for secondary reconstruction of the maxilla and mandible using only stereolithographic models.

Discussion

In the recent past, virtual surgical planning has become a game changer in planning complex reconstruction of maxilla and mandible. This becomes even more important in the cases of secondary reconstruction. Virtual surgical planning requires close interaction between the surgeon and the design and manufacturing team. The latter is often done remotely making the process cumbersome and less user friendly. We have been using a simplified version of the virtual surgical planning at a low cost set up with effective outcomes. This report consists of 22 cases in which secondary reconstruction using osteo-cutaneous free fibula flap was carried out using virtual surgical planning. Mock surgery was performed on stereolithographic (STL) models (face and fibula), pre-bending of plates and fabrication of occlusal splints helped in precise translation of the treatment plan to the operating room which in turn helped in reducing the surgical time and attaining more predictable results.

Conclusion

Secondary reconstruction of maxilla and mandible is complex and requires meticulous planning to achieve optimal and predictable results which directly improves the quality of life of the patients.

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Acknowledgements

The authors acknowledge the support received from Department of Head and Neck Surgery, Department of Plastic & Reconstructive Surgery and Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences, Kochi.

Funding

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Authors and Affiliations

  1. Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Arjun Krishnadas & Pramod Subash

  2. Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Subramania Iyer

  3. Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Deepak Balasubramaniam

  4. Department of Head and Neck Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, Karnataka, India

    Narayana Subramaniam

  5. Department of Plastic Reconstructive Surgery, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, Karnataka, India

    Radhika Kapahtia

  6. Department of Oral and Maxillofacial Surgery, Barnet and Chase Farm Hospitals Wellhouse Lane, Royal Free NHS Foundation Trust, Barnet, UK

    Sony Pullan

  7. Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

    Janarthanan Ramu

Authors
  1. Arjun Krishnadas
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  2. Subramania Iyer
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  3. Deepak Balasubramaniam
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  4. Pramod Subash
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  5. Narayana Subramaniam
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  6. Radhika Kapahtia
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  7. Sony Pullan
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  8. Janarthanan Ramu
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Correspondence to Subramania Iyer.

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Krishnadas, A., Iyer, S., Balasubramaniam, D. et al. Simplified Virtual Surgical Planning Method for Reconstruction of Secondary Maxilla and Mandibular Defects Using Free Bone Flap. J. Maxillofac. Oral Surg. 22 (Suppl 1), 105–109 (2023). https://doi.org/10.1007/s12663-023-01906-7

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  • DOI: https://doi.org/10.1007/s12663-023-01906-7

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